MEDICARE: KELLEY NICOLE SELLERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1902467327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY NICOLE SELLERS

Provider Business Mailing Address
First Line	:	624 SONOMA ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-6070
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5940 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2506
Country	:	US
Telephone Number	:	888-531-8385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	03/19/2026

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